Options Before Reverse Total Shoulder Replacement

Abstract

Management of massive tears of the rotator cuff tears is one of the most difficult problems an upper limb surgeon encounters. Patients with similar tears can present with minimal discomfort through to a flail shoulder. There are a bewildering number of options available, many with published outcomes not always borne out in clinical practise. These range from rehabilitation, simple arthroscopic surgery, attempts at repair, complex tendon transfers and ultimately a reverse total shoulder replacement. More recently further options of patch augmentation and balloon arthroplasty have been added. This paper attempts to provide a critical assessment of the evidence available.